Antenatal corticosteroid treatment may increase the risk of childhood mental health disorders

 1. In a retrospective cohort study, antenatal corticosteroid exposure increased the risk of childhood mental health disorders for late pre-term and term infants.

2. Notable childhood mental health disorders associated with antenatal corticosteroids included developmental delay, attention deficit hyperactivity disorders, and disturbances of emotions.

Evidence Rating Level: 2 (Good)

Study Rundown: Maternal antenatal corticosteroid treatment has been shown to improve survival of preterm infants in addition to reducing the risk of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. However, antenatal corticosteroids in late preterm and term infants has not been shown to have mortality benefits and may lead to neonatal complications such as hypoglycemia and abnormal neurodevelopment. This study aimed to clarify the impact of antenatal corticosteroid treatment on childhood mental health disorders in infants born at various gestational ages, by retrospectively analyzing data from over one million infants born in Taiwan. In this cohort, corticosteroid exposure increased risk of childhood mental health disorders in the entire cohort. When controlled for gestational age, this association was seen in late preterm and term infants, but not in the early preterm infants. More specifically, the use of antennal corticosteroid use was associated with developmental delay, attention deficit hyperactivity disorders, and disturbances of emotions. One limitation of this study is the use of data from health insurance claims diagnoses, which may lead to misclassification bias. Furthermore, the retrospective nature of the analysis places it at risk for confounding by variables that independently increase the risk for mental disorders that were not accounted for by investigators. Overall, this study provides evidence at a population level that administration of antenatal corticosteroids may not be a benign intervention, specifically for late preterm and term infants. Clinicians should engage in shared decision making with families around the indications, timing, and potential risks for this treatment.

Click here to read the article in the Journal of Pediatrics

Relevant Reading: Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation

In Depth [retrospective cohort]: This study included 1,163,443 singleton infants between January 2004 to December 2010 in Taiwan from the Taiwan National Health Insurance Research Database (NHIRD) paired with the Taiwan Maternal and Child Health Database (MCHD), which has includes 99.99% of Taiwan’s population. The cohort was stratified based on gestational age at the first dose of antenatal corticosteroid including (1) < 28 weeks, (2) 28-34 weeks, and (3) >34 weeks. Corticosteroid exposure increased risk of childhood mental health disorders in the entire cohort (adjusted hazard ratio; aHR 1.13, 95% CI 1.08-1.18, p<0.001)s, and the trend persisted in the late preterm (aHR 1.15, 95% CI 1.06-1.25, p=0.001) and term groups (aHR 1.11, 95% CI 1.05-1.16, p<0.001), but not in the early preterm infants (aHR 1.08, 95% CI 0.95-1.23). When looking at specific subgroups of mental health disorders, the use of antennal corticosteroid use was associated with developmental delay (aHR 1.09, 95% CI 1.03-1.15, p=0.002), attention deficit hyperactivity disorders (aHR 1.11, 95% CI 1.05-1.18, p<0.001), and disturbance of emotions (aHR 1.18, 95% CI 1.02-1.37, p=0.029).

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